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LA SALLE UNIVERSITY

NCHN FORM 02

College of Nursing Ozamiz City HEALTH TEACHING PLAN I. II.

TOPIC: _ Nephrotic Syndrome by Rot 4 Group 1_______________________________ GOAL: After the health teaching, the patient or the audience will be able to have adequate knowledge about kidney complications like Nephrotic Syndrome.

SPECIFIC OBJECTIVES

CONTENT

TIME ALLOTMEN T

MATERIALs NEEDED

STRATEGIES/ METHODOLOGY

METHOD OF EVALUATION 

After 2 hours of health teaching, patients and audience will be able to:  Understand the definition Nephrotic Syndrome

WHAT IS NEPHROTIC SYNDROME? Nephrotic syndrome occurs when the filtering units of the kidney called glomeruli are damaged, which allows the protein normally kept in the blood plasma (called protein albumin) to leak into the urine in large amounts, reducing the amount of protein the blood. Protein in the blood is responsible for keeping the fluid intact in the bloodstream. However, damage in the kidneys influence the leakage of this fluid towards the tissues, which leads swelling or edema. This is ultimately caused by the lack of protein in the blood, as it is being expelled through the urine instead, leading to proteinuria.

10 mins

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Lecture and discussion

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Video presentation

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Interaction with the audience. ( question and answer)

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Visual aids (cartolina and marker)

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Laptops, microphone, speaker and projector (for video presentation)

Open forum  

Tokens Printed pictures

Question and answer form with tokens for every correct answer to measure the understanding of the parent(s) or guardian(s).

After 2 hours of interactive lecture:  Participants or audience were able to understand the definition of Nephrotic Syndrome and can give their own comprehension.

In children, there are two types of nephrotic syndrome:  1. Primary - the most common type of childhood NS, which begins in the kidneys and affects only the kidneys 2. Secondary - NS is caused by other diseases examples would include systemic diseases like diabetes mellitus, lupus erythematosus, and amyloidosis 

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To find out the signs and

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Participants or audience were able to point out the signs and symptoms of Nephrotic Syndrome . Participants or audience were able to determine the causes of Nephrotic Syndrome.

symptoms of Nephrotic Syndrome

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Determine the causes of Nephrotic Syndrome

WHAT ARE THE SIGNS AND SYMPTOMS OF NEPHROTIC SYNDROME?

15 mins

Signs and symptoms of Nephrotic Syndrome may include:  Poteinuria: high amount of protein present in the urine (proteinuria)  Hyperlipidemia: high cholesterol and triglyceride levels in the blood  Hypoalbuminemia: low levels of a protein called albumin in the blood  swelling (edema), particularly in your ankles and feet, and around your eyes  Foamy urine - a result of excess protein in urine  weight gain - from fluid buildup in the body  Fatigue - due to severe decrease in kidney function  Appetite loss - Too much protein escaping into the urine (albuminuria) leaves a lack of protein in your blood (hypoalbuminemia), which can result in malnutrition and change your perception about certain foods.

WHAT ARE THE CAUSES OF NEPHROTIC SYNDROME?

15 mins

Nephrotic syndrome happens when you have a disease that damages the filters in your kidneys causes them to not work as they should. There are primary and secondary causes of nephrotic syndrome. Primary causes of nephrotic syndrome are diseases that affect only the kidneys. The most common primary cause of nephrotic syndrome in adults is a disease called focal segmental glomerulosclerosis (FSGS). The only way to know for sure whether you have FSGS is to get a kidney biopsy. Even when treated, most people with FSGS will eventually develop kidney failure and

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Participants or audience were able to verbalize the different complication of Nephrotic Syndrome.

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Participants or audience were able to know the treatment Nephrotic Syndrome.

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Participants or audience were able to how can we help patient with Nephrotic Syndrome

will need to start dialysis or have a kidney transplant to live. After transplant, there is still a chance that FSGS will return and you may lose your new kidney. In children, the most common primary cause of nephrotic syndrome is minimal change disease. Secondary causes of nephrotic syndrome are diseases that affect the whole body, including the kidneys. Most of the time, nephrotic syndrome happens because of secondary causes. The most common secondary cause of nephrotic syndrome in adults is diabetes. The most common secondary cause of nephrotic syndrome in children is diabetes. 

To verbalize the different complications of the Nephrotic Syndrome

WHAT ARE THE DIFFERENT COMPLICATIONS WITH REGARDS TO NEPHROTIC SYNDROME?

20 mins

Possible complications of nephrotic syndrome include: 

Blood clots - The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. This increases your risk of developing a blood clot in your veins.

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High blood cholesterol and elevated blood triglycerides. - When the level of the protein albumin in your blood falls, your liver makes more albumin. At the same time, your liver releases more cholesterol and triglycerides.

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Poor nutrition - Loss of too much blood protein can result in malnutrition. This can lead to weight loss, which can be masked by edema. You may also have too few red blood cells (anemia), low blood protein levels and low levels of vitamin D.

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To know when a person is diagnosed with Nephrotic Syndrome

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High blood pressure - Damage to your glomeruli and the resulting buildup of excess body fluid can raise your blood pressure.

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Acute kidney injury - If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products can build up quickly in your blood. If this happens, you might need emergency dialysis — an artificial means of removing extra fluids and waste from your blood — typically with an artificial kidney machine (dialyzer).

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Chronic kidney disease. - Nephrotic syndrome can cause your kidneys to lose their function over time. If kidney function falls low enough, you might need dialysis or a kidney transplant.

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Infections - People with nephrotic syndrome have an increased risk of infections.

HOW TO KNOW IF YOU’RE DIAGNOSED WITH NEPHROTIC SYNDROME? Healthy kidneys remove extra fluid and waste from your blood but let proteins and other important nutrients pass through and return to your blood stream. The only way to know how well your kidneys are working is to get tested. Tests doctors use for kidneys are: 1.

Urine tests – Your urine test results can tell your doctor if there is protein in your urine. If so, you may have nephrotic syndrome. Protein in the urine is one of the earliest signs of kidney disease.

2.

Blood tests – Your blood test results can tell your

La Salle University College of Nursing- Health Teaching Plan 2019

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doctor if your kidneys are filtering waste like they should. If not, it could be a sign of nephrotic syndrome. 3.

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To know the treatment of Nephrotic Syndrome

Kidney biopsy – In a kidney biopsy, your doctor will look at a small piece of your kidneys under a microscope for signs of damage and disease.

To be sure you do not have a problem with your kidneys, you should have both, a urine and a blood test. Having a urine and a blood test is important because you could have normal blood test results, but you could still have too much protein in your urine. Protein in your urine could mean you have kidney disease. WHAT ARE THE TREATMENTS FOR NEPHROTIC SYNDROME? Treatment for nephrotic syndrome involves treating any medical condition that might be causing your nephrotic syndrome. Your doctor might also recommend medications and changes in your diet to help control your signs and symptoms or treat complications of nephrotic syndrome. Medications might include: 

20 mins

Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the amount of protein released in urine. Medications in this category include lisinopril (Prinvil, Qbrelis, Zestril), benazepril (Lotensin), captopril and enalapril (Vasotec). Another group of drugs that works similarly is called angiotensin II receptor blockers (ARBs) and includes losartan (Cozaar) and valsartan (Diovan). Other medications, such as renin inhibitors, also might be used, though ACE inhibitors and ARBs are generally used first.

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Water pills (diuretics). These help control swelling

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by increasing your kidneys' fluid output. Diuretic medications typically include furosemide (Lasix). Others include spironolactone (Aldactone, Carospir) and thiazides, such as hydrochlorothiazide or metolazone (Zaroxolyn). 

Cholesterol-reducing medications. Statins can help lower cholesterol levels. However, it's not clear whether cholesterol-lowering medications can improve the outcomes for people with nephrotic syndrome, such as avoiding heart attacks or decreasing the risk of early death. Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor).

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To know how you can help patient with Nephrotic Syndrome

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Blood thinners (anticoagulants). These might be prescribed to decrease your blood's ability to clot, especially if you've had a blood clot. Anticoagulants include heparin, warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto).

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Immunesystem-suppressing medications. Medications to control the immune system, such as corticosteroids, can decrease the inflammation that accompanies some of the conditions that can cause nephrotic syndrome. Medications include rituximab (Rituxan), cyclosporine and cyclophosphamide.

HOW YOU CAN HELP PATIENT WITH NEPHROTIC SYNDROME?

20 mins

Nursing interventions for a child with nephrotic syndrome are:  Monitoring fluid intake and output . Accurately

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monitor and document intake and output; weigh the child at the same time every day, on the same scale in the same clothing; measure the child’s abdomen daily at the level of the umbilicus. 

Improving nutritional intake. Offer a visually appealing and nutritious diet; consult the child and the family to learn which foods are appealing to the child; serving six small meals my help increase the child’s total intake better.

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Promoting skin integrity. Inspect all skin surfaces regularly for breakdown; turn and position the child every 2 hours; protect skin surfaces from pressure by means of pillows and padding; protect overlapping skin surfaces from rubbing by careful placement of cotton gauze; bathe the child regularly; a sheer dusting of cornstarch may be soothing to the skin.

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Promoting energy conservation. Bed rest is common during the edema stage of the condition; balance the activity with rest periods and encourage the child to rest when fatigued; plan quiet, age-appropriate activities that interest the child.

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Preventing infection. Protect the child from anyone with an infection: staff, family, visitors, and other children; handwashing and strict medical asepsis are essential; and observe for any early signs of infection.

References:

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https://nurseslabs.com/nephrotic-syndrome/ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613 https://www.healthline.com/health/nephrotic-syndrome#symptoms https://www.kidneyfund.org/kidney-disease/other-kidney-conditions/rare-diseases/nephrotic-syndrome/#nephrotic_syndrome_test https://www.kidney.org/atoz/content/nephrotic

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